HOME WARRANTY INSURANCE CLAIM FORM
STRATA PLAN
Building Insurers’ Guarantee Corporation (BIGCORP) Part 6A Home Building Act, 1989
To assist you in completing your claim form please refer to BIGCorp’s “Home owners guide – Making a home warranty insurance claim under HIH/FAI policies”
1. Policy Number
2. Insurer
3. Property Owner
Strata Plan Number
Contact Agent/Owners
Postal Address
Suburb: Email Address
Post Code:
Telephone Numbers Bus
A/H
Mob
No. of Units in Plan
Where defects relate to a lot property, the owner of that lot must complete a separate insurance claim form (single dwelling or dual occupancy).
4. Property Address
Lot No. Street No. Street/Road
Suburb/Town
Post Code
Please attach a copy of the Strata Plan showing common and lot property
5. Builder
Name of Builder ACN/ABN No.
Contact Person
Licence No.
Postal Address
Suburb: Email Address
Post Code:
Telephone Numbers Bus
A/H
Mob
If more than one builder, please attach separate page(s) with their details and insurance certificate
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6. Developer (if applicable)
Name ACN/ABN
Contact Person
Postal Address Suburb: Email Address Post Code:
Telephone Numbers Bus
A/H
Mob
7. Details of the work
7.1 Did you receive certificate/s of home warranty insurance/s? (If attaching the original, it will be copied and returned to you.) 7.2 When was work completed? Completion of work can be evidenced by one or more of the following: Final Inspection Completion notice signed Date contractor last worked on the premises Please attach a copy of the relevant evidence ____________ / ____________ / ____________ ____________ / ____________ / ____________ ____________ / ____________ / ____________ YES / NO
8. Reason for a Claim
8.1 Please tick the box/es most appropriate to your circumstances and the reason for this claim: Death of builder Insolvency/bankruptcy of builder Defective Workmanship Cancelled licence/registration of builder Disappearance of builder Design Fault Early termination contract
8.2 Describe any outstanding or defective work (attach separate page(s) if required − a building consultant report is helpful)
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8. Reason for a Claim (continued from previous page)
8.3 When did you first become aware of the defects? ____________ / ____________ / ____________ 8.4 Explain/provide evidence of your efforts to resolve the matter with the builder/developer (attach separate page(s) if requried)
Please attach copies of any correspondence between the owner’s corporation and the builder/developer. 8.5 Has there been any legal action in process before a Tribunal or Court? If yes, by whom were the proceedings commenced? YES / NO
If yes, give details and attach a copy of any decision
8.6 Have you made a formal complaint regarding this matter to the Office of Fair Trading? If yes, state the date: ____________ / ____________ / ____________
YES / NO
If yes, please attach copies of letters from the Office of Fair Trading. 8.7 Have you previously made a BIGCORP claim relating to this property? YES / NO
If yes, what is the claim number? ________________________________________
9. Checklist of documents to enclose with the Claim Form (tick where applicable)
1. Strata Plan showing Common and Lot Property 2. Insurance Certificate 3. Proof of ownership 4. Copy of Contract for Sale (first two pages) 5. Evidence of when work was completed as per Question 7.2 All claims approved for payment are subject to a $500 excess payable by the beneficiary. This amount will be deducted from any approved amount paid to the beneficiary. 6. Copies of any consultants reports obtained, photos or other evidence of the defective/incomplete work. 7. Order made by Consumer, Trader & Tenancy Tribunal (CTTT) or court 8. Correspondence notifying the builder/developer of complaints about the building work 9. Correspondence with the Office of Fair Trading
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10. Declaration
I/We acknowledge that to make a claim I/we must return this form with all requested details and information required in the Homeowner’s guide. I/We hereby declare that the statements made on this form are true and that I/we have not withheld any information which would be of assistance to the Building Insurers’ Guarantee Corporation in assessing this claim. Please note, it is an offence under Section 103K of the Home Building Act 1989 to make false or misleading statements in a claim form and that penalties apply for these offences. I/We acknowledge that where appropriate, the claim and information provided may be referred to the contractor, technical consultant/s, rectifying contractor or other person or organisation for the purposes of investigating and determining the claim. Information may also be used for the purposes of marketplace monitoring and for investigative and law enforcement purposes. Owners’ Corporation The strata seal must be inserted here
Signature of Office Bearer/Agent
Date
Name
Position
11. To submit this claim
Return this form to: Building Insurers’ Guarantee Corporation PO Box 972 PARRAMATTA NSW 2124 or lodge this claim at your local Fair Trading Centre
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